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fOR OFFI E-USE: - -------- Permit No. --- --.�' ------------- - ------- - -------------- - APPLICATION FOR SANITATION PERMIT i (Complete in Duplicate) --------------------------------- ---------- Date Issued This Permit Expires 1 Year From Date Issued r Application is hereby made to the San-Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina No. 549. �- ---------------- $ JOB ADDRESS AND LOC N------� ----- - ._. _ -- ---•----------•--....--•---------------------------•---------- -- -- ---------------------------- - -- Owner's Name ------ Phone...... ` •------- :t Address.-----------•-14' ------------ -------_--- ---------------------•--------------•-------- �/}} ��}} t ��-�+ -------------------------------- Installation ••------------••----------•- Contractor's Name----- - ----. --1f�-- - 't-•�- � +� Installation will serve: Residence I partment House [-], Commercial ❑ Trailer Court ❑ Motel r❑ Other ❑ Number of living units: .1- N er of bedrooms .0_. Number of baths I..... Lot size ._. - -d _24— ----- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table _______- ft. Sand Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpen ❑ Character of soil to a depth of 3 feetI 5 ❑ ❑ Y i� Previous Application Made: (if yes,date---------------- -) No ❑ New Construction: Yes ❑ No Ur�'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic ank or cesspool permitted if public sewer,is available within 200 feet.) n Distance from nearest well_________________Distance from foundation--------------------.. Ma#erial------------------------------------------------ No. of compartments-------------------------Size--`----------------------------Liquid depth_---. ----•---------------Capacity-------••--------- D' o gel Distance from nearest welI10QK0__-Distance from foundation....�_.0_fi.._Distance to nearest lot line__ra._._.. Number of lines_:+...�.____ Length of each line_-t'1- --•...------Width of trench.___ . -�.-------•------ ----- ------ ,�- Type of filter maieriai.. k_-Depth of filter material------/_ _ �� _Total length_...•_________________e . f-- istance from foundation____. __.Dista ce to nearest lot line___,_Qt4v Seepage Pit: Distance to near�s we1L_I' �jpj 3 ___ �, �, Number of pits._.___-__.___._____Lining material__--------Size: Diameter__- DistaV�l Distance from nearest well-----------------Distance from foundation-- Lining material..-._______-__._________-.-_-___...._ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------•-Liquid Capacity------•---------•------_-gals. Privy: Distance from nearest well------------: -------------- - ----Distance from nearest building------------------------------------------ _ �- ❑ Distance-to neares�t lot- line-=-=----------• -------------- ---••----•---------------....------------------ ---------•-------- -------•-------•-------- i Remodeling and/or repairing (describe)------------------- /.-- ------------- ••-------•------•--•---------••------• ------•--------- ••--------------t••------ •--------- -------- -----•------•-----------------------••-----•------...-----•-------------------------- -------- -- ------------ -------- ------------ ------------ --- ----- ---•----------------••--------•-----------•----------------- ------•------- •--•----------------------------------------- --- --•----•------------------•------ - I hereby certify that 11,have p pared this application and that the work will be done in accordance with San Joaquin County ordinances, St w , rul and regulations of the San Joaquin Local Health District. t n� ,l �L r ------ ----------- -ntracforj (Signed--- ••-----------•---� -�--�-`-`---- I - -- -i ---- - -------------•---•- BY= •----------------- I I - ------- ---- -------- ----(Tifle)-----------------•-------------------- -- ---- - -------------- ---------- (Plot plan, showing size of lot, location of system in re on to wells, buildi , etc., can be placed on reverse side). F DEPARTME SE O ,. h APPLICATION ACCEPTS --- - --- - -- --- ----- ------ --- - ----------------- DATE-',7--- -- ----------------- REVIEWEDBY------_-------------------------------- ------ DATE---------------- ---- BUILDINGPERMIT ISSUED-------------------------------------- = ------ ------------- = DATE------------------------------ ----------------------------- Alterations and/or recommendations:----•- �' . .__� _•• {L ------------------- - -------------•-• --------------- - --- -- -- - ----------- --- ---------- -- FINAL INSPEC ION BY�. .. - ---- -- -- --- ------ Date__ _. ... •. ------ SAN JOA IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oa Street 124 sycamore Street 205 West 9th Street Stockton,California 1 Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS